HEENT Flashcards
What are somatic senses
Tactile, thermal, pain and proprioceptive sensations
What are visceral senses
Provides sensations to internal organs
What do mechanoreceptors detect
Mechanical deformation of adjacent cells
What do thermoreceptors detect
Changes in temperature
What do nociceptors detect
Pain
What do photoreceptors detect
Light
What do chemoreceptors detect
The presence of chemicals in solution
What do osmoreceptors detect
Osmotic pressure of fluids
Tactile somatic senses are located where
In the skin or subcutaneous tissue
(Touch, pressure, vibration, itch and tickle)
Thermal receptors are located where
In the epidermis and the dermis
Pain receptors are located everywhere except
The brain
Temperatures as low as _____ and as high as ____ can be detected
As low as 50F and as high as 118F
Anything above or below that stimulates pain receptors
What is fast pain characterized as
Acute, sharp or prickling pain. This pain is precisely located
What is slow pain
Chronic, aching, burning or throbbing and is more diffuse
What is proprioception
It is known as the kinesthetic sense or the perception of body movements
Where are proprioceptors located in
The skeletal muscles, tendons, joint and hair cels in the middle ear that monitor the orientation of the head relative to the ground
Where is the olfactory epithelium found
In the inferior surface of the cribriform plate (of the ethmoid bone of the skull)
What is gustation
The sense of taste
What is the five primary tastes
Salt, sweet, bitter, sour and umami
What CN carries taste information from the anterior 2/3 of the tongue
CN VII
What CN carries taste information from the posterior 1/3 of the tongue
CN IX
How do tears flow
From the lacrimal gland through the lacrimal ducts and then drain from surface of the eye through the lacrimal canaliculi and then to the nasolacrimal duct.
The nasolacrimal duct flows into the nasal cavity
What are the six extrinsic muscles that work together to move the eye ball
Superior rectus, inferior rectus, lateral rectus, medial rectus, superior oblique and inferior oblique
What is the middle layer of the eye also called and what three portions compose it?
The vascular tunic
And composed of the choroid, ciliary body and the iris
What is the function of the retina
It is in the posterior three-quarters of the eye and functions in image formation
What do rods allow us to see
Shades of gray in dim light
What do cones allow us to see
They are instrumental in color vision and visual acuity
What is a transparent structure that focuses light rays onto the retina
The lens
What is the pressure in the eye called and what is it produced by
Intra ocular pressure (IOP) and it is produced by the aqueous humor (mainly) and the vitreous body
What is normal IOP
~16 mm HG
It helps maintain the shape of the eyeball and keeps the retina in position and nourished
What is the bending of light rays where two different substances meet.
Refraction
What structure of the eye carries out 75% of refraction
The cornea
What muscle contracts for viewing near objects and relaxes for far objects
The ciliary muscle
When does visual stimulation begin
With the absorption of light rays by the rods and cones of the retina
What vitamin deficiency decreases rhodopsin production and leads to night blindness
Vitamin A
What is the visual pathway to the brain
Rods and cones convey impulses, impulses from ganglion cells are conveyed along axons through the retina to the optic nerve (CN II), the optic chiasm, optic tract and cerebral cortex, and sight is perceived in the primary visual areas of the occipital lobe of the brain. (Right side receives images from the left )
What is the external aspect of the ear that collects sound waves and directs them toward the auditory canal
Auricle
How is the middle ear connected with the upper part of the throat
By way of the auditory tube (Eustachian tubes)
What are the three tiny bones of the middle ear
Malleus
Incus
Stapes
What is the physiology of hearing
Sound waves enter the ear through the external auditory canal, strike the tympanic membrane and are conducted through the ossicles (malleus, incus and stapes)
What is the auditory pathway to the brain
Nerve impulses form the cochlear branch of the vestibulocochlear nerve (VIII) pass to the midbrain and thalamus and ultimately go to the primary auditory area in the temporal lobe
What are the two types of equilibrium
Static and dynamic
What is static equilibrium
Linear acceleration or deceleration
What is dynamic equilibrium
Sudden movements such as rotational acceleration or deceleration
The linkage between the medulla cerebellum and cerebrum enable the cerebellum to play a role in what
Maintaining equilibrium
How large is the thyroid typically
4 cm
And the right lobe is often 25% larger than the left
Fine or coarse hair may indicate what
Related to thyroid disease
What facial features does a person with Down syndrome have
Depressed nasal bridge
Epicanthal folds
Mongloid slant of eyes
Low set ears
Large tongue
How does lupus present on the face
Butterfly rash
Malar surfaces and bridge of nose
Blush with swelling
Scaly red macullopapular lesions
Where is the most common location of a salivary gland tumor
Parotid
Which cranial nerve controls the locator palpebrae superior (elevates and retracts upper eyelid)
CN III
Which cranial nerve controls the superior oblique muscles
CN IV
Which cranial nerve controls the lateral rectus muscle
CN VI
What is the posterior 5/6 of the globe, dense, a vascular white portion of the eye
Sclera
What is the anterior 1/6 of the globe and is continuous with the sclera
The cornea
What is it called when eye lids do not completely close and what is the common cause of that
Lagophthalmos
Common causes are thyroid disease, Bell’s palsy, over aggressive pitosis or blepharoplasty surgical repair
What is it called when the lid is turned away from the eye and may result in excessive tearing
Ectropion
What is it called when the lid is turned inward toward the glove
Entropion
What is an acute supportive inflammation (staphylococcal) of the follicle of an eye lash that forms an erythematous or yellow lump
Hordeolum (stye)
What is crusting along the eyelashes caused by bacterial infection
Blepharitis
What is it called when a pupil fails to dilate in the dark
Miotic
Commonly caused by ingestion of narcotics or drugs that control glaucoma
What is anisocoria
Inequality of pupillary size
What is the pupillary dial action of more than 6mm and failure of the pupils to constrict with light
Myadriasis
May indicate coma or may be caused from the use of eye drops
What is a convergence of small fragile arteries and veins located on the anterior superior portion of the septum
Kiessalbach plexus
What are stensen ducts
Parotid gland outlets that open on the baccalaureate mucosa opposite the second molar on each side of the upper jaw
What are Wharton ducts
Open on each side of the frenulum under the tongue
They drain saliva from the submandibular and sublingual glands to the sublingual caruncle at the base of the tongue
What are ototoxic medications
Aminoglycosides (gentamicin)
Streptomycin
Quinine
Chemotherapy (cisplatin)
Antimalarial (quinine)
Salicylates
Furosemide
Salt-retaining medications such of corticosteroids
Patients with anterior packing should have the packing removed by an experienced health care provider in what time frame
48 to 72 hours
What type of forceps are used in nasal packing
Bayonet forceps
Taste buds are found elevations on the tongue called what
Papillae
The eyeball measures about 2.5cm (1 in) diameter and is divided into three layers, what are those three layers called
Fibrous tunic
Vascular tunic
Retina
The external ear consists of what
Auricle
External auditory canal and eardrum
The middle ear consists of what
Auditory (Eustachian) tube
Auditory ossicles
Oval window
The inner ear consists of what
Bony labyrinth
Membranous labyrinth
Spiral organ (organ of corti) which is the organ of hearing
Most vestibular branch axons of the vestibulocochlear (viii) nerve enter the brain stem and terminate where
Medulla and pons
Other axons extend to the cerebellum
What is myopia
Nearsightedness
What is hyperopia
Farsightedness
What is astigmatism
Irregular curvature of the cornea or lens
To be tasted substances must be dissolved in what
Saliva
The olfactory epithelium is in the upper portion of the nasal cavity and contains what
Olfactory receptors cells
Supporting cells
Basal cells
Impulses conduct via the olfactory tract to where
Limbic system
Hypothalamus
And cerebral cortex (temporal lobe)
What are the receptors of static equilibrium
The maculae
What organ has the broadest area for referred pain
The kidneys
Meissner corpuscles are abundant where
Fingertips
Palms
Soles
What is the ciliary process
Consists of folds on the internal surface of the ciliary body whose capillaries secrete aqueous humor
What is the function of the ciliary muscle
It’s a smooth muscle that alters the shape of the lends for near and far vision (accommodation)
What is the vitreous chamber and what does it contain
It is the larger of the cavities in the eye and lies between the retina and the lens
It contains a clear, jellylike substance called vitreous body and this material helps maintain the shape of the eye and hold the retina in place
The cornea carries out what percentage of refraction
75%
If someone has a positive Rinne test, what does that mean
Normal findings
What is the most common craniofacial congenital malformation
Oropharyngeal clefts
What is the preferred method of cauterization
Silver nitrate sticks
How long will nasal packing stay in place
48 hours
What is blepharitis
A common chronic bilateral inflammatory condition of the lid margins
Anterior blepharitis involves what
Lid skin, eyelashes, and associated glands
It may be ulcerative, because of infection by staphylococci or seborrheic in association with seborrhea of the scalp, brows and ears
Posterior blepharitis results from what
Inflammation of the meibomian glands
What are some symptoms of blepharitis
Itching, burning, mild pain, foreign body sensation, tearing, erythema of the lids and crusting around the eyes upon awaking
What is the treatment for blepharitis
Scrub the eyelid margins twice a day with a commercial eyelid scrub (ocusoft) or baby shampoo on a washcloth
Then
Warm compress for 10 to 15 minutes 1-2x/day
What is a hordeolum
Acute infection that usually involves staphylococcus species
What is a chalazion
Chronic focal granulomatous inflammation within the eyelid secondary to the obstruction of meibomian gland or gland of zeis (hordeolum)
What are some symptoms of a hordeolum
Localized eyelid tenderness, swelling and erythema
May have foreign body sensation
Visible or palpable, well-defined subcutaneous nodule in the eyelid
Associated blepharitis or acne rosacea
The fibrous tunic is divided into two regions, what are they?
The posterior sclera and anterior cornea
What structure regulates the amount of light that passes through the lens
The iris
What structure focuses light rays into the retina
The lens
In color blindness, what cones are missing
Red or green cones
What are the receptor organs for equilibrium called
Saccule, utricle and semicircular ducts
Where are thermorecptors located
In the dermis and epidermis
Cold receptors are in what
The dermis
Hot in the epidermis
Exothalmus or eye bulging is associated with what
Hyperthyroidism
How long do you flush eyes for
15-30 minutes
What is a complication of auricle hematoma and what is the treatment
Cauliflower ear (necrosis of the tissue) treatment is semicircular incision and dissection
What temperature is the fluid used to irrigate the ear
Body temperature or room temperature
What is a common cause of cholesteatoma
Eustachian tube dysfunction
What type of ETD is when it is excessively open
Patulous dysfunction
What type of ETD is dilatory dysfunction
When it fails to dilate appropriately
What is a common cause of mastoiditis
Otitis media
What is the bacteria associated with mastoiditis
Staph aureus
What is the treatment for mastoidtis
Ceftriaxone
2g every 24 hours
What precipitates otitis media
URI or ET block
What is the treatment for otitis media
Augmentin or if PCN allergy Doxycycline or Ceftriaxone
What is a complication of otitis media
Cholestoma or mastoiditis or Central Nervous system infection
Does hearing loss occur at high or low frequency
High
What do you use to remove a foreign body from the ear
Loops and scoops
What is a cause of tinnitus
Damage to the hair cells, which turbulence in the carotid artery or jugular vein could cause
What is a common cause of nasal polyps
Asthma/ allergies
Food allergies has a high association
What is a complication of a nasal bone fracture
Septal hematoma
Nasal deformity
What’s the treatment of a broken nose
Nothing if nondisplaced give acetaminophen
When would you treat sinusitis with antibiotic
After 10 days
Other wise treat with NSAIDS/decongestant
What gives a wet finger appearance
Leukoplakia
What is a cause of leukoplakia
Smoking, alcohol and denture wear
What is the treatment for a PTA
Ceftriaxone and metronidazole
How would you perform the needle aspiration of a PTA if you had to
19-21g needle no more than 1cm incision because of carotid artery placement
What’s the most common siladentitis organism
Staph aureus
When would you see hypopyon
Uvelitis, iritis, and corneal ulcer
If someone says they have an underwater feeling what does that indicate
ETD
If you have a blowout fracture what’s involved
Orbit floor
If you lack a red light reflex what might that mean
Cataracts
What types of cells make a cholesteatoma
Stratified squamous epithelium
What’s a complication of cholesteatoma
Bone erosion
Inner ear erosion
Death
What is the definition of transient vision loss
Usually a couple seconds to an hour. No more than 24 hours
What is seen on gram stain of gonococcal conjunctivitis
Gram negative intercellular diplocci
What is the treatment for a corneal ulcer
Ciprofloxacin
Fluroquinalone
When can you wear contacts again after a corneal ulcer
After cleared by optometry
What anatomical structures are involved in hordeolum and chalazion
Gland of Zeis
Meibomian gland
Where does the blood in a hyphema accumulate
Within the anterior chamber
What anatomical structures are involved in uveitis/iritis
Vascular tunic
Choroid, cililary body and iris
What is commonly seen in a slit lamp exam of uveitis/iritis
Snowflake appearance
What is a usual cause of ptergium
Sunlight exposure
Chronic inflammation
What are symptoms of retinal detachment
Flashes of light, floaters, curtain or shadows over field of vision
What is seen on the fluorecein stain of someone with a flash burn
Microdots on corneal surface
I’m an aurical hematoma where does blood accumulate
Perichondrium
What is signs and symptoms of epiglottitis
Rapidly developing sore throat out of proportion to findings
Thumb sign
What is the CENTOR criteria
Fever (38C)
Lack of cough
Tonsil Exudates
Lymphadenopathy of the anterior cervical
What is the gustatory pathway
Stimulus: To be tasted, substances (tastants) must be dissolved in saliva.
(2) Once dissolved, tastants enter taste pores and make contact with the gustatory hairs.
(3) The results is an electrical signal that stimulates the gustatory receptor cell to transmit a nerve impulse.
(4) Adaptation to taste occurs quickly and the threshold for taste varies for each of the primary tastes
What are Meibomian glands
Meibomian glands in the eyelid provide oils to the tear film. Oil glands along the edge of the eyelids where the eyelashes are found.
What is the retina?
The retina, or inner layer, lies in the posterior three-quarters of the eye and functions in image formation.
What is the function of convergence?
Convergence is the medial movement of both eyeballs so that they are directed on the object being viewed. This allows for binocular vision, which allows the perception of depth and an appreciation of the three dimensional nature of objects.
Structures needed for vestibular senses?
Movement of the hair cells stimulates sensory neurons and transmits impulses to the vestibular branch of the vestibulocochlear (VIII) nerve.
What makes up the borders of the anterior and posterior triangle of the neck?
Anterior triangle – is formed by the medial border of the sternocleidomastoid muscles, the mandible, and the midline.
2) Posterior triangle – is formed by the trapezius and sternocleidomastoid muscles and the clavicle.
What is nystagmus and how do you test for it?
Have the patient follow your finger in a horizontal plane from extreme lateral (temporal) positions. (involuntary rhythmic movements of the eye).
Sustained nystagmus (horizontal, vertical, rotary, or mixed pattern) could be congenital or acquired
What is miosis vs mydriasis
Miosis - pupillary constriction to less than 2 mm.
Myadriasis - pupillary dilation of more than 6 mm and failure of the pupils to constrict with light.
Where is the macula in relation to the optic disk?
It is located approximately 2 disc diameters temporal to the optic disc.
What is exophthalmos?
protrusion of the eye, increased volume of the orbit content, associated with Graves’ disease
What is strabismus?
both eyes do not focus on an object simultaneously
What is bilateral hemianopia?
loss of visual fields close to the temple, usually due to a pituitary tumor, interruption in the optic chiasm
What is homonymous hemianopia?
loss of half of the field of view on the same side, both eyes. Due to a lesion arising in the optic nerve radiation on either side
What are the internal structures of the nose
nasal floor, nasal roof, mucous membrane, olfactory epithelium, septum, cribiform plate, adenoids, turbinates and sinuses.
What structures in the internal nose are key components for olfaction
olfactory epithelium
What are turbinates and what is the function?
curved bony structure and increases nasal surface to warm, humidify and filter
What landmarks demarcate the oropharynx?
bilateral anterior and posterior tonsillar pillars
Structures needed for hearing?
Sound waves enter the ear through the external auditory canal, strike the tympanic membrane, and are conducted through the ossicles (the malleus, incus and stapes).
(2) The stapes repeatedly strikes the oval window, which sets up waves in the perilymph of the cochlea.
(3) Pressure wave changes in the cochlea (spiral organ) move the (4) Pressure wave changes in the cochlea (spiral organ) move the tectorial membrane which moves hair cells that fires action potentials that travel up via the cochlear branch of the vestibulocochlear nerve (CN VIII).
Physical exam of the head (visual and palpating)
note visual inspection of head position, should be upright and still note any tilting, jerking, or bobbing. For palpating, symmetry, tenderness, clicking/locking [TMJ], hair texture, and salivary glands
STENSON DUCTS: parotid (maxillary) 2nd molar
WHARTON DUCTS: Submandibular duct - small papilla at the sides of the frenulum. Enlarged, tender gland → viral, bacterial infection, ductal stone.
Discrete nodule → cyst or tumor
Neck exam of the thyroid:
Note any neck fullness (enlarged thyroid)
-Thyroid lobes (if felt) should be small, smooth, and free of nodules.
-The thyroid is approximately 4 cm, and the right lobe is often 25% larger than the left. -Coarse tissue or a gritty sensation suggests an inflammatory process.
-Hard or irregular nodules suggest malignancy.
-Enlarged and tender thyroid may indicate thyroiditis.
-In a hypermetabolic state (hyperthyroidism), vascular sounds (bruits) may be heard
Know the steps of a proper eye exam?
their right eye to your right eye with the ophthalmoscope in the your right hand. Visualize red reflex, vessels, optic disk, retina or macula
What is the whisper test.
unable to repeat 50% of sounds means they likely have hearing impairment
What appearance of nasal polyps
Translucent/pale
Mucous covered is allergies
Blue in color is chronic
What are common pathogens of otitis media
The most common pathogens are Streptococcus pneumoniae, Haemophilus influenzae, and Streptococcus pyogenes.
